Posttraumatic Stress Disorder Screening Research Articles

Development and evaluation of the Trauma Screener-Intellectual Disability: a post-traumatic stress disorder screening tool for adults with mild intellectual disability or borderline intellectual functioning.

This study aimed to evaluate the validity and reliability of the adult self-report and proxy version of the Trauma Screener-Intellectual Disability (TS-ID) in adults with mild intellectual disability or borderline intellectual functioning (MID-BIF). An optimal cut-off value was determined for the ratio of specificity to sensitivity for predicting the diagnosis of post-traumatic stress disorder (PTSD). The TS-ID was adapted from a Dutch Child and Adolescent Trauma Screener, for use with adults with MID-BIF. Outcomes based on the TS-ID were compared with the presence of PTSD, as classified using the Diagnostic Interview Trauma and Stressors-Intellectual Disability (Mevissen et al. 2018). The TS-ID adult version was administered to 97 participants with MID-BIF who lived in supported housing, whereas the TS-ID proxy version was administered to 92 family members or professional caregivers. The TS-ID adult version showed high internal consistency (Cronbach's α=.94) and excellent validity (AUC=.94) for distinguishing PTSD in adults with MID-BIF. Optimal specificity and sensitivity was found at a cut-off score of 18. Although the TS-ID proxy version demonstrated excellent internal consistency (Cronbach's α=.93), it showed no validity in statistically distinguishing PTSD in adults with MID-BIF. The TS-ID showed favourable psychometric qualities as a screening instrument of PTSD in the case for people with MID-BIF.

Screening for posttraumatic stress disorder (PTSD) in Mozambique: Validation of the Primary Care Posttraumatic Stress Disorder Screen for Diagnostic and Statistical Manual fifth edition (PC-PTSD-5).

The confluence of conflict-, climate-, and public health-related emergencies in Mozambique increases the risk of posttraumatic stress disorder (PTSD). Few brief screening tools for PTSD have been validated in low- and middle-income countries. We aimed to validate the five-item Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), the PC-PTSD-5 in Mozambique. This study recruited 957 participants who completed the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) and PC-PTSD-5, a convenience sample from primary and tertiary care settings in Maputo, Mozambique. Participants were administered a diagnostic interview for psychiatric disorders and the PC-PTSD-5 screening tool. We evaluated the criterion validity of the PC-PTSD-5 concerning the MINI-Plus diagnosis of PTSD, the internal construct validity and reliability using confirmatory factor analysis and Kuder-Richardson 20 (KR-20), discriminant validity of the PC-PTSD-5 in comparison to other common mental disorder and suicide risk screening tools, and measurement invariance of selected cutoffs by age, sex, and comorbidity. Internal consistency of the PC-PTSD-5 was high (KR-20 = 0.837), and confirmatory factor analysis suggested that a single PTSD factor fits the data well. PC-PTSD-5 items were moderately correlated with other psychiatric symptoms. Criterion validity analyses revealed that a cutoff score of 3 provided high specificity (0.833) and moderate sensitivity (0.673). This cutoff score performed optimally across age and gender; however, a cutoff score of 2 was preferred if the participant had no psychiatric comorbidities. Screening with the PC-PTSD-5 may facilitate case detection and linkages to appropriate treatment for individuals affected by potentially traumatic events in Mozambique. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment.

We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring. PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

Physical, Cognitive, Emotional, and Social Health Outcomes of Children in the First 6 Months After Childhood Critical Illness: A Prospective Single-Center Study

Objectives: To describe physical, cognitive, emotional, and social health outcomes of children and their trajectory in the first 6 months after PICU discharge. Design: Prospective, longitudinal observational cohort study. Setting: PICU in a tertiary pediatric hospital in Singapore from January 2021 to June 2022. Patients: One hundred thirty-five children (1 mo to 18 yr), admitted for greater than or equal to 48 hours with at least one organ dysfunction and received PICU therapy. Interventions: None. Measurements and Main Results: Serial self/parent proxy-reported assessments were obtained at: PICU admission, PICU discharge, and 1, 3, and 6 months after PICU discharge. The Pediatric Quality of Life Inventory (PedsQL) scale, Functional Status Scale (FSS), and measures of post-traumatic stress disorder (PTSD) using the Young Child PTSD Screen and the Child and Adolescent PTSD Screen-Parent Version were used. Trajectory groups were identified using group-based trajectory model. One hundred thirty-five children (mean [sd] age, 5.6 yr [5.5 yr]) were recruited. Seventy-eight (52%) were male. The mean (sd) Pediatric Index of Mortality III score was 3.2 (4.1) and PICU length of stay was 10.0 days (21.0 d). The mean (sd) PedsQL total scores were 66.5 (21.1) at baseline, 69.7 (21.4), 75.6 (19.7), and 78.4 (19.8) at 1, 3, and 6 months after PICU discharge, respectively. Overall, the PedsQL and FSS plateaued at 3 months. Our model revealed three distinct trajectory groups. Seventeen and 103 children in the mild and moderate trajectory groups, respectively, demonstrated recovery to baseline. Fifteen children in the severe trajectory group were older in age (mean [sd] 8.3 yr [6.4 yr]), with higher proportion (11/15) of preexisting illness. Five of 15 children in the severe group experienced posttraumatic stress syndrome (PTSS) at 6 months post-discharge. Conclusions: In our cohort of PICU patients, we found three unique trajectory groups. Children in the severe group were older, more likely to have preexisting conditions and at increased risk for PTSS. Early identification and intervention may improve recovery in patients with severe PICU trajectories.

Post-Traumatic Stress Disorder (PTSD) in Trauma Patients.

Post-traumatic stress disorder (PTSD) was first introduced as a diagnosis by the American Psychiatric Association in 1980. This diagnosis, included in the 3rd edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III), was to be considered after someone was exposed to a traumatic event "outside the range of usual human experience and would be markedly distressing to almost anyone." Since then, trauma survivors have been identified as being at risk for the development of post-traumatic stress symptom (PTSS) and post-traumatic stress disorder (PTSD). Despite the recognition of this fact, the screening, recognition, and diagnosis of PTSD in these at-risk populations are inconsistent. In the following review, which is designed for the clinician who is unfamiliar with PTSD and its recognition, diagnosis, and treatment, we introduce the problem in the trauma patient and define its scope. In addition, we discuss the diagnosis of PTSD in trauma patients, special considerations relating to these patient populations, treatment options, and explore future directions for how best to define, study, recognize, and treat this challenging and potentially devastating condition.

Social and Psychological Rehabilitation of Servicemen with Post-Traumatic Stress Disorder

Introduction The growing number of servicemen injured during the war in Ukraine creates a need for effective social and psychological rehabilitation and the identification of early signs of Post-Traumatic Stress Disorder (PTSD). Aims The aim of the study is to identify the need for psychological support for the rehabilitation of servicemen with PTSD. Methods The study employed the Primary Care PTSD Screen (Screen PC-PTSD), the Impact of Event Scale-Revised (IES-R), the 36-Item Short Form Health Survey (SF-36), and the Rogers-Diamond Socio-psychological Adaptation Test. The statistics were processed using descriptive statistics, analysis of variance, and regression analysis. Results This study reported that 29.65% of the servicemen showed signs of PTSD and observed symptoms of intrusion, avoidance, and hyperarousal. It was established that PTSD symptoms reduced the indicators of physical (R2=0.634, p<0.001) and psychological (R2=0.607, p<0.001) components of the quality of life of the servicemen, as well as socio-psychological adaptation (R2=0.576, p<0.001). Conclusion Among the studied servicemen, almost 30% demonstrated signs of PTSD, emphasizing the relevance of the studied problem. The identified negative impact of PTSD on the quality of life of the servicemen proved the importance of their complex social and psychological rehabilitation, involving the use of specific means at each stage. The obtained results can be used in the development of an algorithm for providing socio-psychological assistance to servicemen with signs of PTSD.

Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting

Background: Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied. Objectives: To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening. Research Design: Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs. Subjects: Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic). Measures: The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening. Results: Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21). Conclusions: Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.

Trajectories of Short-Term Post-Traumatic Stress Disorder Symptoms in Patients with Post-Intensive Care Syndrome: A Longitudinal Observational Study.

Post-traumatic stress disorder (PTSD) is a major psychiatric health issue among intensive care unit (ICU) survivors with post-intensive care syndrome (PICS). Although early PTSD intervention has been demonstrated to decrease the risk of progression from acute to chronic PTSD, information on the progression trajectory of short-term PTSD symptoms and modifiable risk factors in PICS patients is limited. This study aimed to explore the clinical progression trajectories of short-term PTSD symptoms and the associated factors in PICS patients by conducting a prospective longitudinal observational study. This study was conducted at a tertiary hospital in China. The impact of event scale-revised was used to collect data on the PTSD symptoms of patients at 1, 2, 3, and 4 months post-discharge from the ICU. The latent growth mixture model was used to construct trajectory models for PTSD symptoms and multivariate logistic regression was used to determine the factors associated with the trajectories. A total of 130 ICU survivors with PICS completed the 4-month short-term follow-up. Our results showed that PTSD symptoms in PICS patients manifested as three trajectories, namely, moderate chronic (n = 17, 13.1%), recovery (n = 25, 19.2%), and resilience (n = 88, 67.7%). Compared with the resilience trajectory, age and female were identified as risk factors for the moderate chronic trajectory, while prolonged ICU stay was a risk factor for the recovery trajectory. Our study showed that short-term PTSD symptoms in PICS patients manifested as moderate chronic, recovery, and resilience trajectories. Additionally, our results showed that PTSD screening should be conducted for critically ill patients, especially younger, female, or long-term ICU patients, immediately after their discharge from the ICU.

Beyond Physical Injury: Routine Screening for Acute Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients – A Longitudinal Cohort Pilot Study

IntroductionEarly identification of children at risk for PTSD is critical for improving mental health outcomes after traumatic injury. Currently, there is no standard PTSD screen for pediatric trauma patients and limited data on long-term quality of life for those who screen positive. MethodsIn 2022, we piloted a comprehensive routine screening program for ASD and PTSD at our Level I PTC. All admitted trauma patients ≥8 years old were eligible for screening. Inpatients were administered the ASC3. Those who screened positive were referred for follow-up and repeat mental health evaluation. PTSD screening (CTSQ, CPSS) and quality-of-life screening (PedsQL™) surveys were administered to eligible discharged trauma patients at 1-month post-injury. Children who screened positive on the CTSQ or CPSS were referred for behavioral health services. Results205 children were screened for ASD using the ASC3. 49/205 children (23.9 %) had a positive screen (score ≥3). 56 children completed PTSD screening at 1-month post-discharge. 14/54 children (25.9 %) screened positive on CTSQ, and 8/50 children (16 %) screened positive on CPSS. There was a significant positive correlation between CTSQ and CPSS scores (r 0.76, ∗P<0.0001). When stratified by screening results, patients who screened positive on CTSQ and CPSS were found to have the most significant correlations with poor School and Emotional Functioning on their quality-of-life inventory. ConclusionEarly screening for ASD may be predictive of later development of PTSD in children. Screening using previously validated tools (ASC3, CTSQ, CPSS) were effective in identifying children with negative emotional functioning lasting beyond the acute phase of physical recovery following injury. CTSQ and CPSS both performed well for screening at one-month post-discharge. Early identification can facilitate timely referral to mental health services to potentially minimize long-term socioemotional impact of PTSD.

Suicidal behaviors among refugee women in Jordan: post-traumatic stress disorder, social support and post-displacement stressors

BackgroundThis paper examines the frequency of suicidal behaviors (suicidal ideation or attempt) among a sample of Syrian refugee women living in non-camp settings in Jordan. We asked several questions surrounding suicide and examined the associations between post-traumatic stress disorder (PTSD), social connectedness, post-displacement stressors and suicidal behaviors.MethodsParticipants (n = 507) were recruited using a clinic-based systematic sampling from four health clinics throughout Jordan in 2018. We used a multivariable logistic regression to examine the hypothesis of whether positive screening for PTSD (PCL-5), social isolation (have no friends or family members available to help), and greater number of post-displacement stressors (PMLD Checklist) is associated with suicidal behaviors.ResultsApproximately one-tenth (9.86%) of participants surveyed reported suicidal behaviors (suicidal ideation or attempt) in the past six months. Our hypothesis was partially supported. In the adjusted multivariable analyses, screening positive for PTSD [OR:4.02 (95% CI:1.33, 12.15)] increased odds of suicidal behaviors, while having one friend or family member available to help when in need [OR:0.31 (95% CI:0.13, 0.78)] decreased odds of suicidal behaviors. We did not find any associations between the number of post-displacement stressors and suicidal behaviors in the multivariable model.ConclusionAgencies and practitioners addressing suicidal behaviors among Syrian refugee women should provide interventions that aim to reduce PTSD symptoms and social isolation. Potential intervention includes screening for mental health symptoms and suicidal behaviors during routine visits with service providers, as well as providing proper mental health and psychosocial support services according to the mapping of available services.

Domestic, family and sexual violence polyvictimisation and health experiences of Australian nurses, midwives and carers: a cross-sectional study

BackgroundDomestic, family and sexual violence is a prevalent health and social issue. Nurses may be exposed to higher rates of this violence in their personal lives compared to the community, but little is known about their polyvictimisation experiences or health and well-being impacts.MethodsAn online descriptive, cross-sectional survey of women nurses, midwives and carer members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch) (response rate: 15.2% of nurses sent an invitation email/28.4% opened the email). Violence survey measures included: intimate partner violence (Composite Abuse Scale); child abuse and sexual violence (Australian Bureau of Statistics Personal Safety Survey items). Health measures included: Short Form-12; Fast Alcohol Screening Test; Patient Health Questionnaire-4; Short Screening for DSM-IV Posttraumatic Stress Disorder; well-being measures included: Connor-Davidson Resilience Scale, social support, and financial stress. Proportions were used to describe the prevalence of violence by sociodemographic characteristics and health and well-being issues; logistic regression predicted the odds of experiencing overlapping types of violence and of experiencing health and well-being outcomes.Results5,982 participants (from a parent study of 10,674 nurses, midwives and carers) had experienced at least one type of lifetime violence; half (50.1%) had experienced two or three types (polyvictimisation). Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault. Any violence was associated with poorer health and well-being, and the proportion of affected participants increased as the types of violence they had experienced increased. Violence in the last 12-months was associated with the poorest health and well-being.ConclusionsFindings suggest a cumulative, temporal and injurious life course effect of domestic, family and sexual violence. The polyvictimisation experiences and health and well-being associations reported by survivor nurses, midwives and carers underscores the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence.

Assessing the utility of the PC-PTSD-5 as a screening tool among a cancer survivor sample.

Hematopoietic stem cell transplantation (HCT) is an intensive and invasive procedure used in cancer treatment that can lead to posttraumatic stress disorder (PTSD) symptoms. These symptoms are frequently overlooked in oncology and general health care settings. The suitability and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within the cancer population remains uncertain. This study aims to evaluate its performance as a brief (five-item) case-finding screening alternative to the longer (20-item) PTSD Checklist for DSM-5 (PCL-5) in survivors who received an HCT 1 to 5 years ago. A total of 817 cancer survivors completed the PC-PTSD-5 and PCL-5 during recruitment for a randomized clinical trial. Optimal cut scores for identifying probable PTSD and item performance were determined using indices correcting for chance and item response theory analyses. Of the HCT sample, 10.4% screened as positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 exhibited strong internal consistency and significant associations with PCL-5 scores (total, r=.82; items, rs=.56-.61). A cutoff score of 2 provided optimal sensitivity for screening (κ[Se]=.95), whereas a cut score of 4 demonstrated the highest efficiency for detecting a probable DSM-5 PTSD diagnosis on the PCL-5 (κ[Eff]=.39). Item response theory analyses indicated that item 4 (numbing) of the PC-PTSD-5 yielded the most informative data, with other items potentially lacking incremental utility. Although not an instrument validation study, these findings offer efficient evidence for using the PC-PTSD-5 as a succinct screening tool among cancer survivors in a clinical context. ClinicalTrials.gov, NCT04058795, registered 8/16/2019.

Civilians under missile attack: post-traumatic stress disorder among the Jewish and Bedouin population of Southern Israel

BackgroundOver the past 20 years, Jewish and Bedouin civilians in southern Israel have faced the ongoing threat of missile attacks from Gaza, with possible mental health consequences. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) among Jewish and Bedouin adult civilians in southern Israel in a period with few missile attacks from Gaza, and no military operations.MethodsThe study population included 389 participants (246 Jews, 143 Bedouins) living within 40 km/25 mi from Gaza for at least 2 years and interviewed between January and March 2023 (before the ongoing war that started on October 7th, 2023). The PTSD Checklist (PCL-5) was used, with a score of 33 as a cutoff point for the presence of PTSD.ResultsCompared to Jews, a significantly lower proportion of Bedouins reported accessibility to bomb shelters and siren warning systems. Overall, 20.3% of the respondents exhibited PTSD. Multivariate analysis revealed that after adjustment for demographic and household characteristics, Bedouins had a six-fold significantly higher probability of PTSD in comparison to Jews (OR 5.6, 95%CI 2.8–10.8). Compared to participants with high socioeconomic status (SES), participants with low SES had a six-fold significantly higher probability of PTSD (OR 6.0, 95%CI 2.2–16.5). Participants who did not have an alarm system had more than two-fold odds for PTSD (OR 2.3, 95%CI 1.1–5.5). Being single, living in urban areas, or having a disability significantly increased the probability of PTSD.ConclusionsThe findings of this study demonstrate a significantly higher prevalence of PTSD among the Bedouin population of Southern Israel. Several sociodemographic characteristics were associated with the increased prevalence of PTSD, the most prominent of which was low SES. Healthcare professionals and authorities should be proactive in screening for PTSD, and provide tailored treatment and support, taking into account ethnical and cultural background. Authorities should address the disparity in bomb shelter access and siren warning coverage between Bedouin and Jewish communities.

Patient-Reported Outcomes and Post-Traumatic Stress Disorder Symptoms in Emergency General Surgery

IntroductionPatient-reported outcomes (PRO) are increasingly recognized as a measure of surgical quality and long-term outcomes. There are few PRO data for patients undergoing emergency general surgery (EGS) procedures. Sudden illness and injury are associated with worse health-related quality of life, symptoms of depression, post-traumatic stress. This study aimed to evaluate PRO and post-traumatic stress disorder (PTSD) symptoms in an EGS population. MethodsPatients who underwent an EGS operation and had quality improvement data available from Jan 2020 to Jan 2021 were eligible for inclusion. Participants completed a survey of demographics, socio-economic status, PROMIS PRO measures for general life satisfaction (GLS), general self-efficacy (GSE), and physical function (PF), and the PCL-5 PTSD symptom screening tool. ResultsOne hundred forty-one patients were eligible for inclusion, 40 (28%) completed the study. Mean PRO scores were 52.5 ± 9.3 for GLS, 48.6 ± 8.0 for GSE, and 48.7 ± 9.6 for PF. 12.5% of patients had a low or very low GLS and GSE score, while 32.5% had mild, moderate, or severe PF scores. Seven patients (17.5%) scored >31 on PCL-5 indicating a positive PTSD screen. Regression analysis found American society of anesthesiology score, emergency case, and lower income associated with lower GLS scores. Age, body mass index, and lower income were associated with lower PF scores. ConclusionsWe found that following EGS most patients have average PRO. This limited study did also identify that there are patients potentially at risk for worse functional and mental health outcomes. We plan to use this data to prospectively evaluate the role that EGS plays in these outcomes and how they can be improved on.

Silent Struggles: Traumatic Brain Injuries and Mental Health in Law Enforcement.

To determine the prevalence of head injuries (HIs), posttraumatic stress disorder (PTSD), and depressive symptoms in law enforcement officers (LEOs) and (2) the association between HIs and psychological health conditions. County-level survey administered via Research Electronic Data Capture. A total of 381 LEOs completed the survey (age=43±11years; 40 [11%] females; time as LEO=1-50years, median=15years). Cross-sectional study. We examined the prevalence of HIs (the Ohio State University Traumatic Brain Injury Identification Method), PTSD (PTSD Checklist-Civilian [PCL-C]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). We used Mann-Whitney U and chi-square analyses to compare PTSD and depressive symptoms between those with and without a HI history. There were 282 (74%) participants who reported a lifetime history of 1 or more HIs; 116 (30%) sustained 1 or more HIs on the job. PCL-C scores ranged 17 to 85 (median=27); 33 (10%) participants met or exceeded the clinical cutoff score of 50 to indicate a positive PTSD screening. Participants with a HI history (median=29) had higher PCL-C scores than those with no HI history (median=24; P <.001), but the proportion of participants who met the clinical cutoff for PTSD was not different between those with (n =28, 11%) and without (n =5, 5%) a HI history (X2=2.52, P =.112, odds ratio=2.18; 95% confidence interval, 0.82-5.83). PHQ-9 scores ranged 0 to 20 (median=3); 124 (36%) participants reported mild or greater depressive symptoms. Participants with a HI history (median=3) had higher depressive symptoms than those with no HI history (median=2; P =.012). The proportion of participants with mild or greater depressive symptoms was higher among those with a HI history (n =99, 39%) than without (n =25, 27%; X2=4.34, odds ratio=1.74; 95% confidence interval, 1.03-2.93). HIs are prevalent in LEOs, which may have consequences for their performance, well-being, and career longevity. PTSD and depressive symptoms are higher in those with a HI history, suggesting LEOs need better traumatic brain injuries and mental health resources.

Comparing the effect of two systems-level interventions on perinatal generalized anxiety disorder and posttraumatic stress disorder symptoms

BackgroundThe Massachusetts Child Psychiatry Access Program (MCPAP for Moms) and PRogram In Support of Moms (PRISM) are designed to help obstetric practices address perinatal depression. PRISM includes the statewide MCPAP for Moms program plus proactive implementation support. ObjectiveThe goal of this study was to understand the impact of these programs on perinatal Generalized Anxiety Disorder (GAD) and Post-traumatic Stress Disorder (PTSD) symptoms among individuals screening positive for depression. Study DesignWe conducted a secondary analysis of 2017–2022 data from a cluster randomized controlled trial of MCPAP for Moms vs. PRISM. We included participants completing a GAD or PTSD screen at baseline (n=254) with antenatal Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10. We assessed change in GAD and PTSD symptoms at from pregnancy (4 to <25 weeks Gestational Age (GA) or 32–40 weeks GA), to 4–12 weeks postpartum and 11–13 months postpartum. We conducted a difference-in-difference analysis to compare symptom change from pregnancy to postpartum. We used adjusted linear mixed models with repeated measures to examine the impact of MCPAP for Moms and PRISM on changes in the Generalized Anxiety Disorder 7 (GAD-7) and the PTSD CheckList (PCL-C). Results: Mean GAD-7 scores decreased by 3.6 (MCPAP for Moms) and 6.3 (PRISM) points at from pregnancy to 4-12 weeks postpartum. Mean PCL-C scores decreased by 6.2 and 10.0 points, respectively, at 4–12 weeks postpartum among individuals screening positive on the GAD-7 (n=83) or PCL-C (n=58) in pregnancy. GAD-7 and PCL-C scores decreased among both groups at 11–13 months postpartum. These changes were clinically meaningful. PRISM conferred a statistically significant greater decrease (2.7 points) on the GAD-7 than MCPAP for Moms at 4–12 weeks postpartum. No differences were found between MCPAP for Moms and PRISM in PCL-C or GAD-7 change at 11–13 months, although both were associated with a reduction in GAD and PTSD symptoms at 4–12 weeks and 11-13 months postpartum. ConclusionBoth MCPAP for Moms and PRISM could help to improve symptoms for individuals experiencing co-occurring symptoms of depression, GAD, or PTSD. PRISM may confer additional benefit in the early postpartum period, although this difference was not clinically significant.

Associations Between PTSD Features and Firearm Ownership and Storage: Results From the PRImary Care Screening Methods (PRISM) Study.

Veterans and active duty service members are significantly more likely to die by suicide using firearms compared to the general population. Not-secure firearm storage (e.g., keeping guns loaded/in an unlocked location) is associated with greater risk for suicide and a third of veteran firearm owners store at least 1 personal firearm unsecured. Veterans and active duty service members are also significantly more likely to be diagnosed with posttraumatic stress disorder (PTSD) than the general population. Symptoms of PTSD are divided into 4 criteria: reexperiencing, avoidance, negative affect, and hyperarousal. Research has suggested that endorsement of hyperarousal symptoms is positively associated with unsecure firearm storage and that avoidance symptoms might be negatively associated with unsecure storage practices. The present study examined the relationship between self-reported firearm ownership and storage practices among each item from the Primary Care PTSD Screening for DSM-IV-TR (PC-PTSD-IV) to explore associations between PTSD features and firearm ownership and storage. Participants were recruited from primary care clinics across 5 military installations in the United States as part of a larger study (Mage = 45.4, SD = 16.9). Among participants (n = 2,685), most of our sample identified as male (51.3%) and white (67.3%) with 61.6% currently serving in the military, 16.8% retirees, and 21.6% family members. PTSD symptoms were assessed using the PC-PTSD-IV and a quarter met the clinical threshold for PTSD. Binomial and multinomial logistic regression analyses were used. Among completed responses, 989 (38.1%) people reported owning guns; among gun owners, 386 (39.0%) reported that they were loaded, and 352 (35.6%) reported they were loaded and unlocked. Endorsement of specific items on the PC-PTSD-IV, including those specific to hyperarousal and avoidance, was not significantly associated with storing firearms loaded and/or in nonsecure locations when controlling for military service. Non-responses to items around firearm storage practices were significantly associated with those individuals meeting the clinical threshold for PTSD according to the PC-PTSD-IV and participants currently serving had higher odds of storing at least 1 personal firearm loaded and both loaded and unlocked. Results from our study highlight similarities and departures from the previous literature on the connection between PTSD and non-secure firearm storage practices. Further research may examine (1) the relation between PTSD symptoms and firearm storage between active duty service members, retirees, and family members and (2) whether non-response to items regarding firearm ownership is systematic.

Gunshot Trauma Patients Have Higher Risk of PTSD Compared With Blunt Trauma and Elective Populations: A Retrospective Comparative Study of Outpatient Orthopaedic Care.

Posttraumatic stress disorder (PTSD) has been extensively studied in patients who have experienced natural disasters or military conflict, but there remains a substantial gap in knowledge about the prevalence of PTSD after civilian orthopaedic trauma, especially as related to firearms. Gun violence is endemic in the United States, especially in urban centers, and the mental impact is often minimized during the treatment of physical injuries. (1) Do patients who experience gunshot wound (GSW) trauma have higher PTSD screening scores compared with patients with blunt or other trauma (for example, motor vehicle and motorcycle accidents or stab wounds) and those with elective conditions (for example, arthritis, tendinitis, or nerve compression)? (2) Are PTSD scores correlated with pain scores in patients with GSW trauma, those with non-GSW trauma, and patients with elective orthopaedic symptoms? We performed a retrospective study of adults older than 18 years of age presenting to an orthopaedic clinic over an 8-month period between August 2021 and May 2022. All patients presenting to the clinic were approached for inclusion (2034 patients), and 630 new or postoperative patients answered study surveys as part of routine care. Patients were divided into three cohorts based on the orthopaedic condition with which they presented, whether gunshot trauma, blunt trauma, or elective orthopaedic symptoms. Overall, the results from 415 patients were analyzed, including 212 patients with elective orthopaedic symptoms, 157 patients with non-GSW trauma, and 46 patients with GSW trauma. Clinical data including demographic information were collected at the time of appointment and abstracted along with results from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, short screening questionnaire, which uses a 7-item scale scored from 0 to 7 (with higher scores representing worse symptoms), and from the numeric rating scale for pain (range 0 to 10). Both questionnaires were routinely administered by medical assistants at patient intake. The proportions of patients completing PTSD scoring were 45% (95) in the elective group, 74% (116) in the group with non-GSW trauma, and 85% (39) in the group with GSW trauma (p = 0.01). We compared the PTSD scores across the three groups and then dichotomized the scores as a negative versus positive screening result at a value of ≥ 4 with further comparative analysis. The correlation between pain and PTSD scores was also evaluated. Patients with GSW trauma had higher mean ± SD PTSD scores compared with those who had non-GSW trauma (4.87 ± 4.05 versus 1.75 ± 2.72, mean difference 3.21 [95% CI 1.99 to 4.26]; p < 0.001) and those who presented with elective conditions (4.87 ± 4.05 versus 0.49 ± 1.04, mean difference 4.38 [95% CI 3.50 to 5.26]; p < 0.001). When dichotomized for positive or negative PTSD screening results, patients with GSW trauma had a higher risk of having PTSD (64% [25 of 39]) compared with patients with non-GSW trauma (27% [31 of 116], relative risk 2.40 [95% CI 1.64 to 3.51]; p < 0.001) and compared with patients with elective conditions (4% [4 of 95], relative risk 15.22 [95% CI 5.67 to 40.87]; p < 0.001). Pain scores were correlated with PTSD scores only for patients with non-GSW trauma (ρ = 0.37; p < 0.0001). No correlation with pain scores was present for patients with GSW (ρ = 0.24; p = 0.16) or patients with elective conditions (ρ = -0.04; p = 0.75). In an orthopaedic clinic population, the prevalence of positive screening for PTSD was highest in the population sustaining gunshot trauma as compared with blunt or other trauma and elective orthopaedic conditions. Interestingly, pain scores correlated with PTSD screening only in the patients with non-GSW trauma. These differences suggest a substantial difference in the populations at risk of PTSD after trauma. Overall, the psychological impacts of gun trauma are poorly understood. The next step would be to prospectively study the differences and timelines of PTSD screening in patients with GSW trauma in comparison with patients with blunt or other trauma to better define the treatment needs in this population. Level III, prognostic study.

Validating the Spanish translation of the posttraumatic stress disorder checklist (PCL-5) in a sample of individuals with traumatic brain injury.

There is controversy regarding the comorbidity of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The present study translated the PTSD Checklist for DSM-5 (PCL-5) to Spanish and validated it in a sample of patients with TBI 6 months after the injury. The study included 233 patients (162 males and 71 females) recruited from four Spanish hospitals within 24 h of traumatic brain injury. A total of 12.2% of the sample met the provisional PTSD diagnostic criteria, and the prevalence was equal between male and female participants. The analysis confirmed the internal consistency of the translated instrument (α = 0.95). The concurrent validity of the instrument was confirmed based on high correlation coefficients of 0.7 and 0.74 with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9), respectively. Exploratory factor analysis also confirmed that the items on the PCL-5 can be differentiated from the GAD-7 and PHQ-9 items. Confirmatory factor analysis (CFA) was used to examine the structural validity of the Spanish translation of the PCL-5 with three different models. CFA partially confirmed the four-factor PTSD model, whereas both the six-factor anhedonia model and the seven-factor hybrid model showed adequate fit. However, the difference between the anhedonia and hybrid models was not statistically significant; moreover, both models showed signs of overfitting. Therefore, the utility of these models should be reexamined in future studies. Overall, the results suggest that the Spanish translation of the PCL-5 is a reliable and valid instrument for screening PTSD symptoms among Spanish TBI patients. The Spanish translation of the PCL-5 is also presented in the manuscript.

Trauma exposure correlates among patients receiving care in federally qualified health centers.

Over 80% of adults in the general population experience trauma. Rates of patients with posttraumatic stress disorder (PTSD) are high in primary care settings and are likely to be even higher in federally qualified health centers (FQHCs). Trauma exposure has been linked to psychiatric symptoms and physical health comorbidities, though little research has focused on FQHC patients. This study addresses this by examining clinical and sociodemographic correlates of specific trauma types among FQHC patients. We analyzed secondary data from patients who screened positive for PTSD and were receiving health care in FQHCs in a clinical trial (N = 978). Individuals who did versus did not experience a specific trauma type were compared using between-group tests. In the sample, 91.3% of participants were exposed to a DSM-5 Criterion A traumatic event, with 79.6% experiencing two or more trauma types. Witnessing a life-threatening event (57.3%) and physical assault (55.7%) were the most common traumatic experiences. Physical health comorbidities and worse physical health functioning were associated with a higher likelihood of exposure to all trauma types, with effect sizes larger than PTSD, ds = 0.78-1.35. Depressive and anxiety symptoms were also associated with a higher likelihood of experiencing nearly all trauma types to a lesser magnitude. People of color, OR = 2.45, and individuals experiencing financial inequities, OR = 1.73, had higher odds of experiencing serious accidents as well as other trauma types. The findings highlight the need for trauma-informed care, including routine trauma and PTSD screening, for FQHC patients.